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1932499498
KERRY DIANE WALLACE
GASTONIA, NC
NPI
1932499498
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
367500000X Nurse Anesthetist, Certified Registered
(Licence: NC 087186)
Enumeration Date
2011-04-18
Last Update Date
2011-04-18
Business Address
-- KERRY DIANE WALLACE CRNA
2525 COURT DR
GASTONIA, NC 28054-2140
Phone number: 704-834-4113
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Mailing Address
-- KERRY DIANE WALLACE CRNA
1550 UNION RD STE B
GASTONIA, NC 28054-5522
Phone number: 704-864-8772
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